Comparison of Two Doses of Cisatracurium (0.15mg/Kg and 0.2mg/Kg) in a Single Centre, Prospective, Comparative, Parallel Group of Patients Undergoing General Anesthesia with Endotracheal Intubation by Studying Ease of Intubation

Main Article Content

Kiran Chheda
Vyankatesh Munje
Alka Halbe

Abstract

Objective : Study the advantages and pitfalls of both 0.15 mg/kg and 0.2 mg/kg of Cisatracurium for Intubation.


Background:  The patients coming to a Tertiary Care Hospital during period 2018-2019 for surgery under General Anaesthesia, who met the Inclusion Criteria were studied in a hundred patients. After giving all components of balanced general anaesthesia, patients randomised into 2 groups either 0.15 mg/kg or 0.2mg/kg of Cisatracurium as a muscle relaxant and Intubation was done at 3 minutes.


Measurements and Results: Heart rate, Blood pressure, Systolic, Diastolic, Mean, SpO2, ETCO2, TOF monitoring at the adductor pollicis, and BIS were monitored for 7 minutes and Intubating conditions in both the groups were evaluated, and scored according to the Steyn’s Modification of Helbo-Hansen Scoring system.


In haemodynamic changes in Group A [0.15 mg/kg] Heart rate and Blood pressure showed an increasing trend before coming down to baseline by 7 minutes. In Group B [0.2mg/kg] the trend was decreasing from baseline after a minor increase in heart rate at 2 minutes and Mean Blood pressure was lower at all intervals when compared to baseline.


Regarding Intubation In Group A maximum number of participants were having good score (56%) followed by poor (30%) and excellent (14%) whereas in Group B excellent score was maximum (62%) followed by good (32%) and poor (6%).


With respect to Train of four stimulation Group B showed decreased response to neuromuscular stimulation from 3 minutes onwards compared to Group A.


Bispectral index monitoring, in both groups, showed a decreasing trend at every time interval.


Conclusion: Cisatracurium is a potent non-depolarising neuromuscular blocking agent and tracheal intubation can be accomplished with good to excellent intubating conditions according to Steyn’s Modification of Helbo-Hansen Scoring System at 3 minutes following 0.15 mg/kg and 0.2 mg/kg of Cisatracurium.
From the study of 100 patients in 2 groups, we found that Cisatracurium in a dose of 3ED95 (0.15mg/kg) has haemodynamic stability in view of Heart rate and Blood Pressure. Cisatracurium at a dose of 0.2mg/kg was more haemodynamically stable than Cisatracurium at 0.15 mg/kg during intubation.

Article Details

How to Cite
Kiran Chheda, Vyankatesh Munje, & Alka Halbe. (2023). Comparison of Two Doses of Cisatracurium (0.15mg/Kg and 0.2mg/Kg) in a Single Centre, Prospective, Comparative, Parallel Group of Patients Undergoing General Anesthesia with Endotracheal Intubation by Studying Ease of Intubation. International Journal of Medical Science and Clinical Research Studies, 3(02), 160–166. https://doi.org/10.47191/ijmscrs/v3-i2-02
Section
Articles

References

I. Eikermann M, Peters J: Nerve stimulation at 0.15 Hz when compared to 0.1 Hz speeds the onset of action of cisatracurium and rocuronium. Acta Anaesthesiol Scand 2000; 44: 170.

II. Sparr HJ, Beaufort TM, Fuchs-Buder T. Newer neuromuscular blocking agents: how do they compare with established agents? Drugs. 2001;61(7):919-42. doi: 10.2165/00003495-200161070-00003. PMID: 11434449.

III. Fodale V, Santamaria LB: Laudanosine, an atracurium and cisatracurium metabolite. Eur. J Anaesthesiol. 2002; 19: 466.

IV. Amann A, Rieder J, Fleischer M, et al: The influence of atracurium, cisatracurium, and mivacurium on the proliferation of two human cell lines in vitro. Anesthesia Analgesia 2001; 93: 690.

V. Leykin Y, Pellis T, Lucca M, et al: The effects of cisatracurium on morbidly obese women. Anesthesia Analgesia 2004; 99: 1090.

VI. Mertes PM, Laxenaire MC, Alla F: Anaphylactic and anaphylactoid reactions occurring during anesthesia in France in 1999–2000. Anesthesiology 2003; 99: 536.

VII. Miller DR, Wherrett C, Hull K, et al: Cumulation characteristics of cisatracurium and rocuronium during continuous infusion. Can J Anaesth 2000; 47: 943

VIII. Lagneau F, D'Honneur G, Plaud B, et al: A comparison of two depths of prolonged neuromuscular blockade induced by cisatracurium in mechanically ventilated critically ill patients. Intensive Care Med. 2002; 28: 1735.

IX. Movafegh A, Amini S, Sharifnia H, Torkamandi H, Hayatshahi A, Javadi M, Cost analysis and safety comparison of Cisatracurium and Atracurium in patients undergoing general anesthesia, European Review for Medical and Pharmacological Sciences, 2013; 17:447-450.

X. Lien CA, Belmont MR, Abalos. The cardiovascular effects and histamine-releasing properties of 51W89 in patients receiving nitrous oxide/opioid/barbiturate anaesthesia. Anesthesiology. 1995;82:1131-8.

XI. Kyo Sang Kim,Se Ung Chon. Clinical Research Article

XII. Korean J Anesthesiology. 1993;26(3):512-519.DOI: https://doi.org/10.4097/kjae.1993.26.3.512

XIII. Assessment of Facial Nerve and Ulnar Nerve Stimulation Methods to Determine the Optimal Time for Tracheal Intubation

XIV. Z.J. Koscielniak-Nielsen et al. (1996) European Journal of Anaesthesiology, 13,

XV. 130-135. Timing of tracheal intubation: monitoring the orbiculares oculi, the adductor policies or using a stopwatch?

XVI. Steyn M.P. et al (1994) Tracheal intubation without neuromuscular block in children. British Journal of Anaesthesia, 72(4), 403–406. doi:10.1093/bja/72.4.403

XVII. Naguib M, Brull SJ and Johnson KB.,Conceptual and technical insights into the basis of neuromuscular monitoring, Review article,Anaesthesia 2017, 72 (Suppl. 1), 16–37

XVIII. Flaishon R, Windsor A, Sigl J, Sebel PS. Recovery of consciousness after thiopental or propofol. Bispectral index and isolated forearm technique. Anesthesiology. 1997 Mar;86(3):613-9. doi: 10.1097/00000542-199703000-00013. PMID: 9066327.

XIX. Fisher DM, Szenohradszky J, Wright PM, Lau M, Brown R, Sharma M, Pharmacodynamic modelling of vecuronium induced twitch depression. Rapid plasma-effect site equilibration explains faster onset at resistant laryngeal muscles than at the adductor pollicis Anesthesiology 1997 Mar;86(3):558-66

XX. Belmont MR, Lien CA, Quessy S. The clinical neuromuscular pharmacology of 51W89 in patients receiving nitrous oxide/ opioid/barbiturate anesthesia. Anesthesiology 1995;82:1139-45.